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Debunking Myths About Epidurals for Childbirth

From a good post by Dr. Harriet Hall debunking various myths about epidural analgesia for childbirth:

In my opinion, it is unconscionable to let patients suffering from severe pain go untreated unless there is compelling evidence that not treating pain results in improved health outcomes. It is even more unconscionable for ideologically motivated people to influence a patient to feel guilty about accepting pain relief. A typical natural childbirth website tells women that if they try but can’t stand the pain, they shouldn’t feel bad about asking for medication. The very fact that they felt compelled to say that is an admission that some women do feel bad. Alarmist midwifery websites ask “Why are so many women taking dangerous drugs during labor?” They  exaggerate the dangers of epidurals, referring to doctors as “drug pushers.” They tell women they should “embrace the full pain of childbirth.

Hall also stresses earlier in the piece that, as autonomous individuals, women have the right to choose unmedicated birth. She just questions why some birth activists are so dogmatic about the purported superiority of unmedicated birth.

Many of the familiar objections to epidurals are based on outdated versions of the procedure. For example, these days, an epidural doesn't necessarily confine the woman to bed. Contrary to popular belief, modern epidurals do not prolong labor, and may even facilitate the process.

The argument is that epidurals have side effects, so it's automatically better to avoid them. That reasoning if faulty. The real question, as in all cost-benefit analysis, is whether the side effects of an epidural are better or worse than the side effects of unmedicated childbirth. Epidurals cause headaches less than 1% of the time.

Whereas, unmedicated birth has a very, very common side effect: Agonizing pain.

Natural childbirth advocates can be very cagey about how much childbirth typically hurts. Some authors even suggest that childbirth is inherently painless, and that every woman would have pain-free delivery, but for modern cultural hangups. 

Dr. Amy Tuteur (aka "the Skeptical OB") had an excellent post a few weeks ago about why childbirth hurts. Women's experiences vary widely. Some report that the pain of childbirth is manageable, others find it excruciating.

As Dr. Amy explains, there are good physiological reasons to expect that, on average, childbirth will hurt like hell. The body is being pushed and pulled in ways that we would expect to hurt, if these stresses were caused by anything else. It should come as no surprise, therefore, that most women report that the process is very painful.

The myth of inherently painless childbirth is often used to guilt-trip women who want pain relief. According to the myth, the pain either isn't real, or could have been avoided if the woman had attained a suitably crunchy mindset.

Not everyone needs heavy duty pain relief in labor, but a significant percentage of women do. Let's not make their needs invisible.

[Image credit: Pierre Marcel, Creative Commons.]

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